Study Shows Texas Maternal Mortality Rate Less than Half of What was Previously Reported

Lisa Hollier, M.D., professor of obstetrics and gynecology at Baylor College of Medicine and medical director at Texas Children’s Health Plan.

By Alexandra Becker |April 10, 2018

The Texas Department of State Health Services (DSHS) announced Monday that the number of maternal deaths in Texas in 2012 was actually less than half of what was previously reported. The new data, based on peer-reviewed DSHS research and published in the journal Obstetrics & Gynecology, found that there were 56 maternal-related deaths in Texas that year rather than 147.

The original numbers, published in 2016, generated widespread criticism and shone a national spotlight on what were deemed the worst maternal mortality rates in the nation and among the worst in the world.

The new study describes how dozens of women were identified incorrectly on their death certificates as being pregnant at the time of death. According to DSHS, this was most likely due to misclassification errors related to a nearly 40 percent increase in the use of electronic death certificates between 2010 and 2012.

Because maternal deaths are calculated based on cause of death codes on death certificates, DSHS researchers went back and verified those deaths by checking them against other medical records, including birth certificates, fetal death certificates, and autopsy reports, which would report signs of pregnancy or miscarriage. That in-depth comparison helped identify the vast disparity between the data reported in 2016 and the actual maternal mortality numbers.

Notably, DSHS said that researchers also identified some maternal deaths originally missed after comparing the different medical records.

This new method for data analysis, coupled with the Texas Maternal Mortality and Morbidity Task Force, which the Texas Legislature established in 2013, were responses to what was already known to be major concerns surrounding the accuracy of death-related data.

In 2017, TMC News spoke to the chair of the task force, Lisa Hollier, M.D., professor of obstetrics and gynecology at Baylor College of Medicine and medical director at Texas Children’s Health Plan, about the state’s spike in pregnancy-related deaths and the likelihood that much of it was based on inaccurate data. The article, which appeared in the June 2017 issue of TMC Pulse, explained that the real story was far more complex.

“We identified multiple problems with the consistency of the evaluation of the maternal deaths,” Hollier said in 2017. “I think there are opportunities for education as well as standardization regarding those evaluations to ensure that the appropriate information is collected at the time of death so that a complete assessment of the cause of death can be made.”

Despite fewer deaths and more accurate data analysis, the fact remains that maternal mortality is a significant health concern in Texas and beyond.

“Every maternal death is a tragedy and we should strive for a case rate of zero,” said Sean Blackwell, M.D., maternal-fetal medicine specialist at Children’s Memorial Hermann Hospital and department chair for obstetrics, gynecology, and reproductive sciences at McGovern Medical School at UTHealth, when he spoke to TMC News in 2017. In addition to errors in the numbers, he said, the issue wasn’t that maternal medical care in Texas hospitals was worsening, but that too many women were not receiving the care they needed.

“The major current opportunity for improvements is related to making sure women have access to care, especially our most vulnerable patients who are underserved and have chronic or severe medical conditions,” Blackwell said. “We sorely need to have the system infrastructure and the ability to follow these women through that first year post delivery.”

DSHS stated that it will continue efforts to reduce maternal-related deaths by supporting the work of the task force as well as hospitals throughout the state—including the need for more access to care. The agency is also working to further improve the quality of data collected and the methods of investigating and reporting maternal deaths.

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